Thinking about switching from a Medicare Advantage plan back to Original Medicare and adding a Medigap policy? You're not alone. Many beneficiaries find themselves reconsidering their coverage, especially when their healthcare needs change. In this guide, we'll walk you through the process of making the switch—and what to watch out for along the way.
Table of Contents
🔁 Why People Want to Switch
Many Medicare beneficiaries decide to switch from Medicare Advantage to Medigap coverage when they realize the limitations of their current plan. A Medicare Advantage plan may offer low premiums and extra benefits, but it often comes with network restrictions and cost-sharing surprises. If you’re considering a switch from a Medicare Advantage plan, you’re likely seeking broader provider choice and more predictable out-of-pocket expenses.
Traditional Medicare combined with a Medicare supplement—also known as Medigap—can offer that predictability. Medigap policies help cover what original Medicare doesn’t, like coinsurance, copayments, and deductibles.
✅ Eligibility to Make the Switch
To switch back to original Medicare and enroll in a Medigap plan, you must first be enrolled in Medicare Part A and Part B. You cannot have both a Medicare Advantage plan and Medigap coverage at the same time.
The ideal time to enroll in a Medigap policy is during your Medigap Open Enrollment Period. This window begins the month you are 65 or older and enrolled in Part B. During this time, you can enroll in a Medigap plan without medical underwriting.
If you’re outside this window and want to switch from a Medicare Advantage plan to Medigap, you may be subject to medical underwriting and denied coverage depending on your health history. This is one of the biggest cons of switching from Medicare Advantage to Medigap outside of protected periods.
🧭 Step-by-Step Guide
- Review Your Current Coverage: Evaluate the pros and cons of switching from Medicare Advantage and determine whether a Medigap plan better meets your needs.
- Check Your Enrollment Period: You can switch during the Medicare Advantage Open Enrollment Period (January 1–March 31) or Medicare Open Enrollment (October 15–December 7).
- Disenroll from Your Medicare Advantage Plan: Contact Medicare or your current plan provider to initiate the disenrollment process.
- Enroll in Original Medicare: If not already enrolled, you’ll need to switch to original Medicare (Part A and Part B).
- Apply for a Medigap Policy: Shop for a Medicare supplement insurance plan. If you don’t qualify for guaranteed issue rights, approval for Medigap may involve medical underwriting.
- Enroll in a Part D Plan: Medigap policies do not include prescription drug coverage, so you’ll need to enroll in a standalone Medicare Part D drug plan.
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⚠️ Common Roadblocks
- Medical Underwriting: If you're not in a guaranteed issue period, your application for Medigap could be declined.
- Timing Issues: Enrollment periods can limit when you are able to switch.
- Loss of Extra Benefits: Many Medicare Advantage plans include dental, vision, and wellness perks not covered by Medigap.
- Confusion About Coverage: It’s essential to understand that Medigap policies only work with original Medicare—not Medicare Advantage plans.
❓ FAQ
Can I switch back to original Medicare and get a Medigap plan?
Yes, but the ability to enroll in a Medigap plan without underwriting depends on your timing and eligibility.
When can I switch from Medicare Advantage to Medigap?
During the fall Medicare Open Enrollment or the Medicare Advantage Open Enrollment Period. Outside these windows, options may be limited.
What if I can’t pass medical underwriting?
You may not be approved for Medigap coverage if you're outside your initial enrollment or a guaranteed issue period.
Do I need to cancel my Medicare Advantage plan?
Yes. You must disenroll from your Medicare Advantage plan before Medigap coverage begins.
Will I need a separate drug plan?
Yes. You'll need to enroll in a standalone Medicare Part D plan for prescription drug coverage.
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Explore Plans📝 Conclusion
Switching from a Medicare Advantage plan to a Medigap policy can feel overwhelming—but for many, it’s a worthwhile move toward more predictable and flexible healthcare coverage. If you’re unhappy with your current plan’s network, out-of-pocket costs, or limitations, returning to original Medicare with a Medigap plan may offer the peace of mind you're looking for.
That said, timing is critical. Enrollment periods, medical underwriting, and prescription drug needs all play a role in whether making the switch is feasible—or financially smart—for you right now. Be sure to compare your Medicare options, understand your eligibility, and take advantage of the best possible enrollment window.
When in doubt, speak with a licensed Medicare advisor or use trusted tools to compare Medigap policies in your area. With the right information and timing, you’ll be able to make the switch with confidence.
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